Provider Demographics
NPI:1992298764
Name:NAVAL HOSPITAL CAMP PENDLETON
Entity type:Organization
Organization Name:NAVAL HOSPITAL CAMP PENDLETON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MTF SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:43500 RIDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3624
Mailing Address - Country:US
Mailing Address - Phone:951-308-2200
Mailing Address - Fax:
Practice Address - Street 1:43500 RIDGE PARK DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3624
Practice Address - Country:US
Practice Address - Phone:951-308-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL CAMP PENDLETON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy